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Above Knee Gait Analysis

Above Knee Gait Analysis

ABDUCTED GAIT

Characterised by a very wide base with prosthesis having a significantly greater or wider base than normal (normal range 2"-4"). Possible reasons for this condition are:

1) Prosthesis too long
2) Socket has too much adduction built into it or too much abduction in the prosthesis.
3) Incorrect shape to medial wall, causing amputee to hold limb away to avoid pressure in the ramus area.
4) If mechanical hip joint fitted, position of joint and band incorrect.
5) Socket set too far medially and in adduction.

ADDUCTED GAIT

Characterised by a very narrow base with prosthesis sometimes catching the sound side.
Possible reasons for this condition are:

1) Socket set with too much abduction or prosthesis set in too much adduction.
2) Mechanical hip joint in an incorrect position.
3) Socket set too far laterally and in abduction.

CIRCUMDUCTION

The prosthesis swings through in a wide curved arc during swing phase. Possible reasons for this condition are:

1) Prosthesis too long.
2) Too much friction in knee.
3) Socket not fitting adequately.
4) Socket too tight making limb long or causing muscle tension to rotate limb on toe-off.
5) Inadequate suspension allowing prosthesis to slip.
6) Foot set in too much planter flexion.
7) Muscle weakness or confidence in prosthesis.
8) Inadequate use of the knee.

DROP-OFF

At the end of stance phase the patient moves forward over the prosthesis in a characteristic downward movement over the foot. Possible reasons for this condition are:

1) Inadequate dorsiflexion or prosthetic foot.
2) Foot too short.
3) Socket too far anteriorly set over the knee.
4) Hyperextension of socket.


FOOT SLAP

At heel strike the foot flexes rapidly and the front of the foot strikes the floor hard, often resulting in a slapping sound being heard. Possible reasons for this condition are:

1) Heel rubber or planter flexion bumper too soft.

LATERAL BENDING OF TRUNK

Excessive bending of trunk lateral from the midline in stance phase onto prosthetic side.
Possible reasons for this condition are:

1) Prosthesis too short.
2) Discomfort of socket on medial wall.
3) Discomfort at distal aspect of stump.
4) Abducted socket or prosthesis aligned in abduction.
5) Incorrect socket shape allowing movement across the midline.
6) Patient may have weak abductors.

LUMBAR LORDOSIS

Excessive extension of trunk in stance phase. Possible reasons for this condition are:

1) Flexion in stump.
2) Insufficient flexion of socket in prosthesis.
3) Pain at ischial seating.
4) Weak extensors and/or weak abdominal muscles.
5) Patients general balance.

INSTABILITY OF PROSTHETIC KNEE

The prosthetic knee tends to bend or give way at heel strike or stance phase. Possible reasons for this condition are:

1) Prosthesis incorrectly aligned. Thigh/socket too far posteriorly set of TKA line (trochanter-knee-ankle line).
2) Insufficient flexion built into alignment of limb.
3) Heel or planter flexion of foot too hard.
4) Weak hip extensions.
5) Stride length too long.


ROTATION OF FOOT AT HEEL STRIKE

Foot rotates laterally when foot comes into contact with the ground (heel strike). Possible reasons for this condition are:

1) Heel rubber or heel wedge too hard.
2) Socket fit too lose.
3) Control of socket on new suction wearer.
4) Check for lateral whip.

TERMINAL SWING IMPACT

Rapid forward movement of shin with the knee reaching full extension with force, and too early before heel strike. Possible reasons for this condition are:

1) Insufficient knee friction.
2) Extension aid adjusted incorrectly – aid too strong.
3) Amputee forcing limb through to assure themselves of extension before heel strike.

UNEVEN ARM SWING

Arm of the patient on prosthetic side held still and close to the body during locomotion. Possible reasons for this condition are:

1) Incorrectly fitting socket causing discomfort.
2) Insecurity/fear of limb dropping.
3) Habit – bad gait pattern.

UNEVEN HEEL RISE

The prosthetic foot rising very sharply and higher than the sound side. Possible reasons for this condition are:

1) Insufficient friction would cause heel to rise too high.
2) Excessive friction would stop the heel rising sufficiently.
3) Extension aid incorrectly adjusted or absent causing insufficient heel rise or heel to rise too high.

UNEVEN LENGTH OF STEP

Step length differs from amputated side to sound side. Normally long prosthetic step length and short sound side. Possible reasons for this condition are:

1) Insufficient flexion accumulated on limb.
2) Pain in socket causing amputee to transfer quickly onto sound side.
3) Insufficient dorsiflexion in foot, not allowing patient to achieve rollover.

UNEVEN TIMING

Steps of unequal duration. Possible reasons for this condition are:

1) A number of other alignment problems.
2) Incorrectly fitting socket causing pain.
3) Insufficient friction or weak extension aid causing high or low heel rise.
4) Flexion contracture
5) Insecurity – bad balance.

VAULTING

Characterised by the patient raising his entire body plantar flexing his foot excessively. Possible reasons for this condition are:

1) Prosthesis too long – incorrect length.
2) Socket too small causing prosthesis to look long.
3) Foot too far plantar flexed.
4) Insufficient flexion of prosthetic knee. ? knee lock.
5) Socket suspension inadequate.
6) Habitation.

WHIP THRO SWING PHASE

Characterised by medial or lateral whip of the knee at the beginning of swing phase and through to heel strike. Possible reasons for this condition:

1) Incorrect alignment of knee and hip joint through socket.
2) Socket too tight – insufficient room for muscle and tensing causing lateral rotation.
3) Plantar rubber too hard at the off.
4) KK on thigh.

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